[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5083 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5083

To amend title XVIII of the Social Security Act to provide for coverage 
 of certain services furnished by opioid treatment programs under the 
                           Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 23, 2018

 Mr. Neal (for himself and Mr. Pallone) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
    addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
 of certain services furnished by opioid treatment programs under the 
                           Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Access to Evidence-Based 
Opioid Treatment for Seniors Act of 2018''.

SEC. 2. MEDICARE COVERAGE OF CERTAIN SERVICES FURNISHED BY OPIOID 
              TREATMENT PROGRAMS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (FF), by striking at the end ``and'';
            (2) in subparagraph (GG), by inserting at the end ``; 
        and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(HH) opioid use disorder treatment services (as 
                defined in subsection (jjj)).''.
    (b) Opioid Use Disorder Treatment Services and Opioid Treatment 
Program Defined.--Section 1861 of the Social Security Act is amended by 
adding at the end the following new subsection:
    ``(jjj) Opioid Use Disorder Treatment Services; Opioid Treatment 
Program.--
            ``(1) Opioid use disorder treatment services.--The term 
        `opioid use disorder treatment services' means items and 
        services that--
                    ``(A) are furnished for the treatment of opioid use 
                disorder at an opioid treatment program enrolled under 
                section 1866(j) by a physician or other practitioner 
                that is enrolled under such section; and
                    ``(B) are certified by the Substance Abuse and 
                Mental Health Services Administration to be provided by 
                such program for such treatment.
            ``(2) Opioid treatment program.--The term `opioid treatment 
        program' means an opioid treatment program (as defined in 
        section 8.2 of title 42 of the Code of Federal Regulations, or 
        any successor regulation) that has an opioid treatment program 
        certification (as defined in such section) in effect and meets 
        such other conditions of participation as the Secretary may 
        find necessary in the interest of the health and safety of 
        individuals who are furnished services by such program.''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (BB)'' and inserting 
                ``(BB)''; and
                    (B) by inserting before the semicolon at the end 
                the following ``, and (CC) with respect to opioid use 
                disorder treatment services, the amount paid shall be 
                equal to 80 percent of the amount determined under 
                section 1834(w)''.
            (2) Payment determination.--Section 1834 of the Social 
        Security Act (42 U.S.C. 1395m) is amended by adding at the end 
        the following new subsection:
    ``(w) Opioid Use Disorder Treatment Services.--
            ``(1) In general.--The Secretary shall pay to an opioid 
        treatment program (as defined in paragraph (2) of section 
        1861(jjj)) a bundled payment under this part for opioid use 
        disorder treatment services (as defined in paragraph (1) of 
        such section) that are furnished during an episode of care (as 
        defined by the Secretary) beginning on or after January 1, 
        2020, to an individual by a physician or other practitioner at 
        such program. Such payment shall be in lieu of any payment that 
        would otherwise be made under this part to such physician or 
        practitioner for furnishing such services.
            ``(2) Payment amount.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                amount of a bundled payment under this subsection, with 
                respect to opioid use disorder treatment services (as 
                so defined) furnished during an episode of care (as so 
                defined) beginning during 2020 or a subsequent year, 
                shall be an amount determined by the Secretary that is 
                based on the rates of payment for comparable services 
                that are paid under State plans under title XIX.
                    ``(B) Periodic updates.--The Secretary shall, as 
                determined necessary by the Secretary (but not less 
                frequently than once every 5 years), review and update 
                the amount of a bundled payment under this subsection 
                with respect to opioid use disorder treatment services 
                (as so defined) furnished during an episode of care (as 
                so defined).''.
    (d) Including Opioid Treatment Programs as Medicare Providers.--
Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended--
            (1) in subsection (e)--
                    (A) in paragraph (2), by striking at the end 
                ``and'';
                    (B) in paragraph (3), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(3) opioid treatment programs (as defined in paragraph 
        (2) of section 1861(jjj)), but only with respect to the 
        furnishing of opioid use disorder treatment services (as 
        defined in paragraph (1) of such section).''; and
                    (D) in subsection (j), by adding at the end the 
                following new paragraph:
            ``(10) Enhanced oversight for opioid treatment programs.--
        The Secretary shall establish procedures to provide that opioid 
        treatment programs (as defined in paragraph (2) of section 
        1866(jjj)) enrolling or reenrolling under this title are 
        subject to enhanced oversight, including by requiring annual 
        audits by the Inspector General of the Department of Health and 
        Human Services for each of the first 5 years of such enrollment 
        or reenrollment of such program under this title and audits as 
        deemed necessary by the Inspector General for each subsequent 
        year of enrollment or reenrollment of such program under this 
        title to ensure compliance of the program with the requirements 
        of this section.''.
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